The Effect Of Pedicle Screw On Spinal Growth And Development In Preschool Children With Congenital Scoliosis

BackgroudCongenital Scoliosis is caused by abnormal vertebral development,mostly by poor vertebral segmentation and dysplasia.The formation of hemivertebra caused by the latter is the main cause of congenital scoliosis,which can lead to serious curvature and imbalance of spinal growth,and then affect the longitudinal growth and the development of thoracic and lung in children.Therefore,early surgery is needed to correct and block scoliosis and maintain the growth potential of the spine.The technique of pedicle screw was first introduced and used by Boucher in the 1950 s.Several studies have compared pedicle screw technology with other spinal internal fixation techniques(pedicle hook,lamina hook,sublaminar wire,sublaminar cable,etc.).It has been proved that pedicle screw technology has significant advantages in scoliosis correction rate,revision rate,intraoperative bleeding volume,incidence of complications,fixation and fusion segment and operation time.Pedicle screw fixation has been widely used in adolescents and adults with scoliosis,and its clinical advantages have been confirmed.In recent years,pedicle screw technology has been widely used in the treatment of young children with congenital scoliosis.However,little research has been done on the influence of pedicle screw implantation on the growth and development of the spine in young children.ObjectiveTo evaluate the effect of pedicle screw internal fixation on the growth and development of vertebral body,adjacent unscrewed vertebral body,normal vertebral body and spinal canal in preschool children with congenital scoliosis.Materials and methodsThe imaging data of scoliosis children treated by Professor Liu Fuyun in pediatric orthopaedics department of the Third Affiliated Hospital of Zhengzhou University five years ago were collected and analyzed retrospectively.A total of 32 children who met the inclusion criteria participated in this study.All the children were taken full spine X-ray and CT before operation and at the last follow-up in the Third Affiliated Hospital of Zhengzhou University.According to the different types of vertebral body,they were divided into three types: normal vertebral body,screw-inserting vertebral body and adjacent non-screw-inserting vertebral body.The following morphological parameters were measured on the imaging data of preoperative,one year after operation and the last follow-up in all groups: Vertebral Superoinferior Diameter(VS),Vertebral Anteroposterior Diameter(VA),Vertebral Mediolateral Diameter(VM),Pedicle Height(PH),Pedicle Length(PL),Spinal Canal Transverse Diameter(CAT),Spinal Canal Anteroposterior Diameter(CAP).Results1.Thirty-two patients were enrolled in this study.A total of 96 segments of the spine were measured.The average age of surgery was 33.6 months(9-72 months)and the average follow-up time was 84 months(60-146 months).2.There were significant differences in the anterior and posterior diameter,upper and lower diameter,left and right diameter of vertebral body,pedicle length,pedicle height,anterior and posterior diameter of vertebral canal between all screw-inserting segments and adjacent non-screw-inserting segments and normal segments.3.There was no significant difference in the six parameters of anterior and posterior diameter,left and right diameter of vertebral body,pedicle height,pedicle length,anterior and posterior diameter of vertebral canal,and transverse diameter of vertebral canal between normal and adjacent segments without screw.There was significant difference in the parameters of upper and lower diameter of vertebral body between normal and adjacent segments without screw.Conclusion1.Pedicle screw implantation has dual effects on the growth and development of the vertebral body.It not only has the ability to hinder the growth and development of the vertebral body,but also has the ability to promote the growth and development of the pedicle and the anterior and posterior diameter of the spinal canal.2.For children with congenital scoliosis,early surgery should be performed to reduce the number of pedicle screw implants as much as possible,so as to reduce the number of suppressed vertebrae and affect the height of the children as little as possible.